Labour’s stewardship of the NHS has left “a legacy of missed opportunities” according to local MP Lynne Featherstone, after research revealed that Haringey’s levels of childhood obesity are higher and life expectancy lower than the England average after 13 years of Labour government.
Despite announcing in 1997 that reducing health inequality would be a key priority for the new Labour government, figures show that in Haringey, childhood obesity and life expectancy still lag behind the national average.
A report from the Public Accounts Committee also found that the gap in life expectancy between the poorest areas and the national average grew by 7% for men and 14% for women over the last 13 years. The report also revealed that people living in the poorest neighbourhoods in England die almost two years before those in the rest of the country.
Under proposals put forward in the Health and Social Care Bill by the Coalition Government the responsibility for public health will be returned to local government. By giving Local Authorities the responsibility for commissioning the majority of public health services, local communities will be empowered to come together to tackle the challenges they face.
After 13 years of Labour Government:
o Britain has amongst the worst levels of obesity in the world.
o Smoking claims over 80,000 lives a year.
o 1.6 million people are dependent on alcohol.
o Over half a million new sexually transmitted infections were diagnosed last year, and one in ten people getting an infection will be re-infected within a year.
Lynne Featherstone MP comments:
“New Labour entered government in 1997 and announced that they would put reducing health inequalities at the heart of tackling the root causes of ill-health. Instead after 13 years of government Labour’s real legacy is a story of missed opportunities.
“Tackling health inequality only became a NHS priority in 2006, and primary care trusts were not required to report back on them until 2007. That is why in Haringey we have among the highest levels of childhood obesity in the country.
“Councils are best placed to bring together all the local agencies who can work together to tackle public health challenges. The Coalition’s proposals to return the responsibility for public health to local government will ensure that tackling health inequalities and improving people’s health is given a local focus to fit local circumstances.
“As a result of these changes, local government won’t just be commentators on health but will instead have a new role shaping the direction of local health services.”
Lynne Featherstone
Lynne Featherstone 
You have been MP for this area for several years now – and you’ve just noticed that it has health inequalities – unfortunately just at the same moment at which you’ve decided to help dismantle the NHS and force devastating cutbacks in local government funding. I was talking to someone about you the other day – well, I say talking, I mean mutually criticising and we started to wonder just how thick-skinned you must be. We decided that you must be around 95% skin – and this post proves it.
“The Coalition’s proposals to return the responsibility for public health to local government will ensure that tackling health inequalities and improving people’s health is given a local focus to fit local circumstances.”
How does this strategy relate to the Coalition’s policy of imposing massive cuts on local government, I wonder?
Who think that “returning the responsibility for public health to local government” means “taking no Central Government responsibility”
And if the Liberal Democrats are going to be the Conscience of the Coalition your party and your leader have already revealed themselves to be a bunch of hypocritical morally bankrupt chancers whose “solemn vows” are meaningless.
ALTERNATIVE SOLUTIONS TO THE COALITION GOVERNMENT’S PROPOSALS IN THE HEALTH AND SOCIAL CARE BILL TO ADDRESS THE PROBLEMS IN THE NHS
Richard Taylor – Retired physician, Independent MP for Wyre Forest and Health Select Committee member 2001 – 20101 – 2 February 2011
The most important battles the NHS should be concentrating on now are:
Improving efficiency and value for money while cutting the NHS deficit,
Improving safety and quality of care across the NHS,
Improving patient and public participation in decisions about NHS services nationally,
Strengthening commissioning, especially for quality of service provided, and as a part of this improving communication and co-operation between primary care and hospital doctors.
These apparently conflicting aims, when successfully addressed will all lead to improved health outcomes and can be effectively implemented by strengthening existing NHS organisations and initiatives rather than creating new ones.
A.Methods to Improve efficiency, productivity and value for money while cutting the deficit:
Details of some of the following are available in the transcript of oral evidence on ‘Value for money in the NHS’ taken before the House of Commons Health Select Committee on 25 March 2010 and in the record of a debate in Westminster Hall on 2 March 2010 (Hansard: column 237WH).
See also Health Select Committee first report of 2009 – 10 on Alcohol, HC 151-1 and Obesity report (third report of 2003-04, HC 23-1). Health Select Committee publications are available on the Parliamentary Health Select Committee website.
i. Wider use of standardised, evidence-based clinical practice by expanding periodic, mandatory refresher courses.
ii. Shift secondary care to primary care more successfully.
iii. Spread the use of the Productive Ward Initiative – better named Releasing Time to Care.
iv. No slash and burn cuts.
v. No reduction in PCTs’ management staff and make board members and senior managers of provider trusts more visible and accessible to patients and staff.
vi. Consider paying off PFIs now.
vii. Provide better advice and training to patients to Increase self-care for minor ailments and long-term conditions.
viii. Ensure greater awareness of ‘Never Events’ and increased use of prevention of falls policies.
ix. Promote awareness and enforcement of the NPSA’s Better Care, Better Value indicators.
x. Consider holding a public debate on health care rationing accepting that the NHS cannot keep pace with all the costs of increasing longevity and medical advances..
xi. Continue to reduce smoking levels. Reduce health and social damage to individuals and financial costs to the NHS from alcohol abuse by effective minimum pricing of alcohol. Tackle obesity more effectively by reviewing and implementing the 69 conclusions and recommendations in the Health Select Committee report on Obesity mentioned above.
B. Methods of improving safety and quality of care across the NHS:
i. Promote a uniformly compassionate and open health service and improve communication and continuity of care by better training of all staff in non-technical skills
ii. Push for a more effective and user-friendly NHS complaints process with early, obligatory independent review. Inform all complainants of the need to be accompanied by an independent ‘friend’ to all meetings from the first one relating to the complaint.
iii. Give greater emphasis to ‘never events’ and their eradication (also A.viii above).
iv. Review the safety and effectiveness of primary care out-of-hours services including vetting of language and clinical skills of overseas doctors performing out-of-hours duties.
v. Make sure the Safer Patient Initiative is adopted throughout the NHS.
vi. Encourage whistle blowing by staff, patients and families by forming an independent national group to whom whistle blowers could go first with protected anonymity.
vii. The coalition government is to be congratulated for their implementation of pilots of the 111 telephone line for urgent health care advice that does not warrant a 999 call, for their planned reduction in the complexity of the electronic summary health care record and for investigating ways of allowing some health workers, for better training and continuity of care, to work slightly longer hours than those dictated by the European Working Time Directive.
For more details of the above see Health Select Committee Reports on
Patient Safety, sixth report of 2008-09, HC 151-1, and The use of overseas doctors in providing out-of hours services, fifth report of 2009-10, HC 441.
The following vital sentence is taken from the summary of the Patient Safety report:
“All Government policy in respect of the NHS must be predicated on the principle that the first priority, always without exception, is to ensure that patients do not suffer avoidable harm.”
C. Methods to improve patient and public involvement in NHS decisions
Public involvement in the NHS has been ineffective since the abolition of Community Health Councils just when many were beginning to find they had teeth and to use them. Their successors the Patient Forums were mostly ineffective and obscure but again just as the best were becoming effective they were abolished and Local Involvement Networks (LINks) established. These have never been adequately funded or supported by the Department of Health but despite this some are working hard and effectively. The lack of interest and support means they now appear to be going to be overlooked further with the proposed HealthWatch. Will this, under the auspices of the Care Quality Commission, really be as independent as is required?
Our plan would be to continue with LINksby recognising and developing their potential and supporting them fully. The work of the good ones should be spread to all LINks. Two representatives from each LINk should automatically be full members of the local NHS trust boards.
GP practice Patient Participation Groups should have formal working arrangements with LINks and work together in alliance to unify and strengthen public involvement.
Foundation Trust board meetings must be open to the public and of reasonable frequency (at least six per year) with at least 45 minutes on the agenda allocated for public participation.,
See Health Select Committee reports on Patient and Public Involvement in the NHS, seventh report of 2002-03 and third report of 200607.
D. Improving commissioning of health care
See the Health Select Committee report on Commissioning, (the fourth report of 2009-10, HC 268-1).
Although this report was critical of PCTs’ commissioning skills, it found that some PCTs were improving in their ability to commission for quality as well as price. Therefore it is the wrong time to abolish them to start afresh with new commissioning consortia. The report’s recommendations should be acted upon.
i. Obtain reliable figures for the costs of commissioning and if these prove that it is uneconomic abolish the purchaser/provider split.
ii. While awaiting the result of i. strengthen PCTs’ commissioning role and increase the input of elected doctors into commissioning decisions. Some central control will have to be retained to ensure that every PCT continues to commission essential core services for their populations to retain a uniform national health service.
iii. Even if PCT commissioning is retained, the barrier between purchasers and providers must be bridged to allow hospital consultants to talk with their GP colleagues before decisions are made. The total split between hospital and primary care doctors has been divisive and damaged the close working relationship between primary and secondary care that was one of the huge benefits from the NHS before the internal market was introduced by the Conservative government in 1991.
Conclusions
Andrew Lansley is correct in his aims – to secure health outcomes as good as anywhere.
But his proposed solution is wrong overall, lacks evidence to support its main changes and is untenable because of the inevitable delaying effect it will have on tackling the existing, urgent challenges for the NHS which have been listed above.
Some other examples within the developing NHS of services that must be addressed without the distractions of inappropriate reforms include:
The British Medical Journal, 9 October 2010, stated that six out of ten heart attack patients in England were then treated with primary angioplasty. This was good – but – when will this be improved to nearer ten out of ten of those patients suitable?
Still only a small proportion of stroke patients receive scans within three hours of the onset and thus have the possibility of life-saving or disability-limiting thrombolytic therapy if indicated. When will this significant therapeutic advance be made more widely available?
Are hospitals now carrying out, and acting on, risk assessments of all patients that will reduce, with cheap easily available treatment, the appalling 25,000 avoidable deaths from venous thrombo-embolism to which the Health Select Committee drew attention in 2005?
A former health minister said in concluding his remarks in the debate on reducing NHS expenditure on 2 March 2010: “We face a great challenge but we can overcome it by improving the quality of care, reducing the costs at the same time and delivering within NHS budgets, while recognising that the highest priority of the NHS must always be patient safety and ensuring that we improve the quality of patient care.”
APPENDIX – USEFUL QUOTES in full from the Health Select Committee Commissioning Report that show the evidence, or lack of it, about the cost of the internal market with its inevitable consequence, the purchaser/provider split:
1. House of Commons Health Committee, Commissioning, Fourth Report of Session 2009-10, HC 268-1, published 30 March 2010, Conclusion and recommendation number 1:
“Whatever the benefits of the purchaser/provider split, it has led to an increase in transaction costs, notably management and administration costs. Research commissioned by the DH but not published by it estimated these to be as high as 14% of total NHS costs. We are dismayed that the Department has not provided us with clear and consistent data on transaction costs; the suspicion must remain that the DH does not want the full story to be revealed. We were appalled that four of the most senior civil servants in the Department were unable to give us accurate figures for staffing levels and costs dedicated to commissioning and billing in PCTs and provider NHS trusts. We recommend that this deficiency be addressed immediately. The Department must agree definitions of staff, such as management and administrative overheads, and stick to them so that comparisons can be made over time.”
2. Commissioning Report paragraph 182:
“The current health system with the purchaser/provider split is expensive to run with high administrative and management costs. As we have seen in chapter 2, we have tried rather unsuccessfully over the years to extract information about these costs from the Department and have received a variety of figures ranging from 3-8%; academic research has concluded the costs are much higher amounting to 20-25% of total staff costs or 14% of the total cost of the NHS, i.e. the staggering sum of £13 billion per year.”
500 hundred jobs going at St Georges in Tooting? What’s going to happen at the Whittington? Have you got you excuses prepared?
“Naughty David Cameron made me do it, electorate!”